Organization
RETINA INSTITUTE OF CALIFORNIA MEDICAL GROUP
Active
Organization subpart
No
Provider details
NPI number
Authorized official
TOM S CHANG MD (OWNER)
(626) 568-8838
Entity
Organization
Contact information
Practice address
58471 29 PALMS HWY, 203, YUCCA VALLEY, CA 92284-5818
(760) 853-3005
(760) 853-3012
Mailing address
100 E CALIFORNIA BLVD, PASADENA, CA 91105-3205
(626) 269-5357
(626) 574-7188
Taxonomy
Speciality
Code
Description
License number
State
152W00000X
Optometrist
—
—
207W00000X
Ophthalmology Physician
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1760541569
—
CA
Enumeration date
12/19/2016
Last updated
03/29/2021
Update your record
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